Comparing fundus autofluorescence and infrared imaging findings of peripheral retinoschisis, schisis detachment, and retinal detachment

Abstract

Purpose: The primary goal of this study was to identify characteristic features of peripheral degenerative retinoschisis (RS), schisis detachment (SD) and retinal detachment (RD) on both fundus autofluorescence (FAF) and infrared (IR) imaging, using spectral domain optical coherence tomography (SD-OCT) imaging of the peripheral retina as the confirmatory imaging tool.

Methods: This is a descriptive case series study. A total of 27 eyes of 22 patients were included. Thirteen eyes of 10 patients diagnosed with RS, 4 eyes of 3 patients diagnosed with SD, and 10 eyes of 9 patients diagnosed with RD were included. Patients with images of poor quality were excluded. Heidelberg Spectralis HRA + OCT machine (Heidelberg Engineering, Heidelberg, Germany) were used to acquire the images.

Results: All conditions appeared as areas of hypo-AF on FAF and hypo-reflectance on IR imaging. Accentuated vasculature of the lesion was noted with IR imaging due to elevation of the RS and RD, which was less frequently observed with FAF. On FAF, a hyper-AF leading edge around the RS lesion indicated the presence of intraretinal or subretinal fluid and an extension of the RS. Retinal breaks/holes were best visualized with IR imaging. SD-OCT confirmed the diagnosis in all performed cases.

Conclusions: We were unable to differentiate between RS and RD based solely on findings from FAF and IR imaging. However, the combination of them with SD-OCT can assist in the diagnosis of RS from RD and in the evaluation of RS progression. OCT remains the main modality imaging to differentiate these conditions.

Keywords: Fundus autofluorescence; Infrared imaging; Retinal detachment; Retinoschisis; Schisis detachment; Spectral domain optical coherence tomography.

Conflict of interest statement

The Authors declare that there is no conflict of interest.

© 2020 The Authors.

Figures

Fig. 1

Characterization of retinoschisis on multiple imaging modalities. Patient with retinoschisis underwent imaging with FP (A), FAF (B), and IR imaging (C). Note the difficulty in discerning the edge of retinoschisis in FP, which is better shown in both FAF and IR imaging (white arrows). OCT scan indicated by green line in C is shown (D), highlighting that retinoschisis extends along the hyper-reflective signal (green arrow) past the hypo-reflectance border (red arrow). OCT scan indicated by blue line in C is shown (E), demonstrating low-lying retinoschisis (blue arrows) in the hyper-reflective leading edge of the lesion. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

Comparison of retinoschisis on FAF (left column) and IR imaging (right column). On FAF (A, C, E), three patterns of retinoschisis were observed, including patchy (A), confluent (C), and granular (E). Furthermore, intensity of hypo-AF varied among different retinoschisis patterns ranging from mild (E) to intense (A & C). A well-defined hyper-AF leading edge of retinoschisis (C) was observed. On IR imaging (B, D, F), areas of retinoschisis display hypo-reflectance and increased vascular prominence (F). Outer retinal holes (B) are visualized in retinoschisis on IR imaging. White arrows indicate borders of retinoschisis, red arrows indicate a hyper-AF leading edge, and yellow arrows indicate retinal holes. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3

Multimodular imaging follow up on one case of retinoschisis that progressed to schisis detachment. A-C Retinoschisis Diagnosed with Infrared (IR) imaging (A), color funduscopy (B) and OCT (C); D- F were taken two months later, with a new retinal outer hole (yellow arrow) visualized on IR imaging (D) only and not on AF (E) while OCT still shows retinoschisis (F); G-I were images taken in a two-month following the previous (D-F) with an enlarging retinal hole (double yellow arrows) demonstrated on IR imaging (G). The AF images shown in H and K were taken by Optos. OCT at this time showed progression to a schisis detachment (I). Four months later, Optos AF (K) guided laser retinopexy were employed to stabilize the Retinoschisis lesion. IR imaging (J) and OCT (L) demonstrated chronic enlarged retinoschisis. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 4

Characterization of schisis detachment on multiple imaging modalities. A schisis detachment shown on FP (A), FAF (B), IR imaging (C), and OCT (D & E) after laser retinopexy. Horizontal (D) and vertical (E) OCT of the lesion edge demonstrated the hyper-reflective leading edge as low-lying retinal schisis (between blue and red arrows) or schisis detachment (between yellow and green arrows). (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 5

Characterization of retinal detachment on multiple imaging modalities. A bullous retinal detachment demonstrated on FP (A), FAF (B), IR imaging (C), and OCT (C′). Note the contours of the bullous retinal detachment on FP are better visualized on FAF and IR imaging (white arrows). OCT scan indicated by green line in C is shown (C′). The hyper-reflective leading edge on IR imaging was shown as low-lying retinal detachment shown between the green arrow and red arrow. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)